Seattle Hospitals Brace For Wave Of COVID-19 PatientsThe wave of critical patients is expected to arrive first at Seattle-area hospitals, which have spent recent weeks trying to shore up supplies of "staff and stuff." No one is sure they have enough.

The first reports of COVID-19 deaths in America came from the Seattle area, and the number of cases have been mounting ever since. Hospitals there are not yet at capacity, but things are tense as they prepare for what's coming. NPR's Martin Kaste reports from Seattle.

MARTIN KASTE, BYLINE: We're still at the empty tent stage of this crisis at EvergreenHealth Hospital in Kirkland. Nurse Barbara Jensen shows off the blue tent that they pitched outside the emergency entrance.

BARBARA JENSEN: We have a big diesel heater here, so that we can keep the space warm. And it can be configured in any way we want it.

KASTE: They could fit 30 beds out here, but right now, the idea is to use the tent to test suspected coronavirus patients and keep them from contaminating the emergency room, which is still relatively quiet.

JEFF TOMLIN: It almost feels like a calm before the storm, honestly.

KASTE: Jeff Tomlin is EvergreenHealth's CEO. He and his staff have spent the last weeks watching the news of overwhelmed hospitals in Italy while getting ready for whatever is coming here.

TOMLIN: We don't know where this is going. We're praying that the social distancing and all those things have been invoked are going to keep those numbers down. But we're preparing for - that it won't.

KASTE: They've been canceling other medical procedures to clear out beds and trying to stock up on supplies. Despite some shipments from the Feds, medical staff around Seattle say they're still being asked to conserve protective gear like masks and gowns by reusing them or wearing them too long, putting their own health at risk. EvergreenHealth, for instance, has had a number of staff get the virus, though it won't confirm how many or whether it happened at work. One doctor in his 40s is known to be in critical condition.

While keeping enough staff on hand is the biggest concern, another pinch point here may be the supply of ventilators, the machines to help critical COVID-19 patients breathe. Mary Shepler is Evergreen's chief nursing officer.

MARY SHEPLER: We've really looked at our ventilator capacity over the last 10 days and have started to look at where we can rent.

KASTE: Yes, rent. Renting gear is something that hospitals often do during bad flu seasons. But there are only so many rentals available, so Evergreen is also looking elsewhere, say, the shuttered long-term care facility where it found 16 ventilators or even the mobile units used for transport. They think they can double their capacity, but Shepler says that will also mean finding enough of the right staffers.

SHEPLER: So we've been looking at which of our RNs were respiratory therapist before. Who in our doctor pool can do ventilator management?

KASTE: Ventilator manufacturers have been ramping up production, but in the meantime, some doctors are now contemplating more improvised measures.

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CHARLENE IRVIN BABCOCK: On this YouTube, I'd like to show you how to modify one ventilator to ventilate two or four patients simultaneously.

KASTE: This is an emergency room physician in Detroit named Charlene Irvin Babcock. She co-wrote a paper a few years ago on how to split air tubing to share a ventilator between multiple patients in a crisis. In this demo video she posted a few days ago, she acknowledges this would be an extreme measure.

(SOUNDBITE OF YOUTUBE VIDEO)

IRVIN BABCOCK: If it was me, and I had four patients and they all needed intubation, and I only had one ventilator, I could pick one to live. We can try to have all four live. But this is clearly off-label and likely would only be used in a dire circumstance, which we may see with COVID-19.

KASTE: Hospitals in Seattle hope that they've prepared enough to avoid such dramatic steps. The county is adding more sites to treat less serious cases away from the hospitals. And the emergency response network here has set up a system to move resources around to where they're needed most. Even ventilators could be shared. Francis Riedo is an infectious disease doctor at Evergreen.

FRANCIS RIEDO: My hope is that in four to eight weeks, people will look at this and wonder why we did all this because they will view it as having been completely unnecessary. I don't think that's going to be the case.

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